Payment contribution steps

The system builds on payment contribution steps, where each person pays proportionally less as his or her costs because of medicinal products increase during a 12-month period. In the first step, a person pays the full cost for medicine; in the second step 15% of the cost and in the third step 7.5%. When the cost reaches a certain maximum, a doctor can apply to Icelandic Health Insurance (IHI) for 100% payment contribution from IHI for the remainder of the period, after specified conditions are fulfilled. 

All medicines that have payment contribution from IHI, including medicines approved in medicinal product certification, are included in the payment steps. The medicine that IHI does not contribute in, fall outside the payment steps.

See which medicinal products IHI contributes to payment.

Those who need medicine often/regularly therefore generally pay less. Those who do not need to purchase medicine often will generally pay more.

The 12-month payment period starts with the person's first purchase of medicine. If, for example, a person buys medicine on 15 May 2018, the payment period ends on 15 May 2019. A new period begins when the person buys medicine for the first time after the above period is over.

Medicine cost calculated by Medicinal Products Calculator

Medicinal Products Calculator  enables you to calculate the cost of medicine, based on given premises. Those curious to see how the cost of medicinal products accumulates in the new system are encouraged to acquaint themselves with the calculator.

Check the status of medicine purchases in the Benefits portal

The Benefits portal shows you a summary of your medicinal product purchases and step status. Login requires electronic ID or an Ice-key. After login click on "My Rights Status" and then "Medicinal products purchases - step status" 

Registration into the Benefits portal

Payment steps — medicinal product purchases

Amounts in payments steps and an example of medicinal product purchases can be seen in the tables below.  People, aged 67 and older, disability pensioners, children and youth's younger than 22 pay lower amounts than others. All children in the same family, who are under the age of 18, pay as one person.

Payment contribution in general

Steps Medicinal product costs over 12‑month period  Payment percentage
Individuals Total coast Individuals Health Insurance
1 ISK 22,000 ISK 22,000 100% 0%
2 ISK 31,750 ISK 87,000 15% 85%
3 ISK 62,000 ISK 490,333 7.5% 92.5%
Total ISK 0 ISK > 490,333       

People, aged 67 and older, disability pensioners, children and youth's younger than 22.

Steps Medicinal product costs over a        12-month period Payment percentage
Individuals Total coast Individuals Health Insurance
1 ISK 14,000 ISK 0 100% 0%
2 ISK 20,875 ISK 57,000 15% 85%
3 ISK 41,000 ISK 325,333 7.5% 92.5%
Total ISK 0 ISK > 325,333       

Prices of medicinal products

The Medicinal Product Payment Committee determines the prices of medicinal products in accordance with the medicinal product price list below, which is issued each month. If a medicinal product is registered with a zero (0) under the category "Payment code" Icelandic Health Insurance does not pay for the medicinal product, and it therefore falls outside the payment steps. IHI makes payment contributions for all other medicinal products, which come under a payment step in the payment contribution system.

IHI's payment contribution is based on the reference price of the medicinal product, if it is available (see column farthest to the right in the price list). A reference price is the lowest maximum price of generic medicinal products. If a reference price is lower than the price of a medicinal product, the person pays the difference. That price does not fall under a payment steps.

Medicinal Products Price List

Medicinal product certificates

Medicinal product certificates increase payment contributions from Icelandic Health Insurance for medicinal product costs exceeding general rules. A doctor applies for a medicinal product certificate that is issued upon the fulfillment of certain conditions in accordance with the work rules specified below.

Medicinal products are either eligible for payment contribution (G-code) regardless of medicinal product category, or they are not eligible for payment contribution (0-code). Medicinal products eligible for payment contribution fall under the payment steps. In the system medicinal product certificates, on one hand, confirms rights to payment contributions to medicinal products not eligible for payment contribution (0-code) and, on the other hand, grants full payment contribution after individuals have paid a maximum amount in accordance with the above payment steps. In all instances, a doctor applies to IHI for medicinal product certificates.

An exception to this is that a medicinal product certificate will be issued for a 100% payment contribution from Icelandic Health Insurance when alleviate nursing treatment at home in the final steps of kidney failure or serious psychosis is involved.

Medicinal product certificates are issued in accordance with the work rules specified below.

See which medicinal products receive payment contributions.

Medicinal product certificates are electronic

Medicinal product certificates are electronic, and pharmacies receive confirmation from IHI of the rights granted by medicinal product certificates for the purchase of medicinal products.

The status of medicinal product certificates can be checked in the  Benefits portal, which publishes, for example, information on approved certificates, such as the period of validity and names of medicinal products. We urge those expecting medicinal product certificates to enter their e-mail addresses in the Benefits portal under "My Settings" because IHI will send notices to registered e-mails when a decision has been made.

Remedies regarding medicinal product payments

Dispensing smaller quantities

In certain instances, pharmacies can be requested to sell smaller quantities of medicinal products. For example, pharmacies can dispense one month's quantity at a time, despite a prescription specifying a three-month quantity.

Reimbursement for high expenditures

Person's, who earn low wages and incur high payments because of medical assistance, medicinal products or training, may have the right to reimbursement for part of the expenses from the State Social Insurance Administration (TR).

Payment distribution

Most pharmacists by far have become parties to an agreement on the distribution of medicinal product costs because of payment difficulties. Under the agreement person's having difficulties paying for medicinal products because of low income or unexpected medicinal product costs can spread out payments. The distribution of costs is at no cost to the person.  See information on payment distribution and a list of pharmacists offering distribution of payments in Icelandic or contact us for further information.




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